Provider Demographics
NPI:1043337017
Name:MORNEY, SUSAN D (LMP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:MORNEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99445
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-0445
Mailing Address - Country:US
Mailing Address - Phone:253-582-3348
Mailing Address - Fax:253-582-3348
Practice Address - Street 1:11122 GRAVELLY LAKE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1348
Practice Address - Country:US
Practice Address - Phone:253-582-3348
Practice Address - Fax:253-582-3348
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012316225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist